Skeletal Muscle Relaxants

Question 1

Neuromuscular blockers

Answer 1

Block at nicotinic receptors
-Competitive non depolarizing
-Depolarizing

Question 2

Spasmolytic drugs

Answer 2

Centrally acting - Backofen diazepam
Direct - Dantrolene

Question 3

Others

Answer 3

Inhibit synthesis
Inhibit release
Inhibit storage

Question 4

Synthesis

Answer 4

Hemicholinium
Triethylcholine

Question 5

Inhibit release

Answer 5

++Mg –Ca
Local anaesthetic like procaine
Botulinum toxin

Question 6

Inhibit storage (in vmVESicles(

Answer 6

Vesamicol

Question 7

Botulinum used in

Answer 7

Ocular blepharospasm and strabismus
Oesophagus achalasia
Generalised spastic disorders like cerebral palsy
Overactive bladder

Question 8

Neuromuscular blocking (poorly lipid soluble so tiny CNS) plus inactive orally so parenteral)

Answer 8

Larger muscles are more resistant and recover rapidly
Diaphragm is the last

Question 9

Atracurium

Answer 9

Hofmann(spontaneous)elimination
With NO effect on muscarinic receptors and slight histamine release

Question 10

Cisatracium

Answer 10

Mostly spontaneous release
With NO effect on muscarinic receptors and NO histamine release

Question 11

TuboCURARine - prototype
It and atracurium cause hypotension

Answer 11

Kidney elimination with NO effect on cardiac muscke and MODERATE histamine release

Question 12

Panacuronium

Answer 12

Kidney elimination With MODERATE blockade of muscarinic receptors and NO histamine release
*Tachycardia

Question 13

Rocuronoum - least potent, fastest onset and rapid action

Answer 13

Liver and Kidney elimination With SLIGHT effect on muscarinic and NO histamine release
*Yet it has allergic reactions

Question 14

Sugammadex

Answer 14

Forms complex with rocuronium to get it away from NM junction

Question 15

Local anaesthetics causing depression, increasing blood flow and decreasing the sensitivity of the postjunctional membrane to depolaridation from best to worst

Answer 15

Isoflurane, sevoflurane, halothane and nitric oxide

Question 16

Higher doses of local anaesthetics

Answer 16

Block nicotinic receptors

Question 17

Antibiotic synergism

Answer 17

Aminoglycosides

Question 18

Antiarrhythmic synergism - class 2

Answer 18

Quinidine

Question 19

Does myasthenia gravis count as a synergist?

Answer 19

Yes

Question 20

Advanced ages as a synergist?

Answer 20

Yes
Decreased clearance of drugs

Question 21

Decreased Neuromuscular blockade

Answer 21

Anticholine esterases
Sugammadex - no rocuronium and rancuronium
Burns
UMNL

Question 22

Depolarizing agents

Answer 22

Succinylchoiline causing unresponsive depolarization in phase 1 - block
Prolonged exposure causing desensitisation in phase 2

Question 23

Hydrolysis of succinylcholine

Answer 23

Butyrylcholine - liver
Pseudocholine - plasma

Question 24

Side effects of succinyl

Answer 24

Arrhythmia and bradycardia
Respiratory apnea - fresh frozen blood for phase 1
Malignant hyperthermia because of anaesthetics and the succinyl
*treat with dantrolene
Hyperkalemia

Question 25

Centrally actingnspasmolytic drugs

Answer 25

Diazepam at GABA A synapses

Question 26

Baclofen - drowsiness with eventual tolerance

Answer 26

And agonist at GABA B
*reduces pain by inhibiting substance p

Question 27

Substance p

Answer 27

Neurokinin1

Question 28

TizAnidine

Answer 28

Alpha 2 Adrenoceptor
Causing hypotension drowsiness and dry mouth

Question 29

Gabapentin

Answer 29

Antiepileptic spasmolytic in MS

Question 30

Newer Gabapentin

Answer 30

Pregabalin

Question 31

Direct

Answer 31

Dantrolene through Ryr inhibition so no calcium
IV or ORAL